Disability

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Disability

The purpose of the disability assessment is to determine if there is a reduction in consciousness in the casualty and any potential cause. For example, whilst the casualty may initially appear to be alert and talkative, under a more detailed assessment you may find the casualty had lost consciousness during the event, has newly onset confusion, or there is evidence of a significant head injury.

An initial consciousness assessment should be performed using ACVPU:

  • Alert – responds normally and is oriented
  • Confused – newly onset confusion, incoherent speech, or is disoriented
  • Voice – responds to verbal stimulus
  • Pain – responds only to painful stimulus
  • Unresponsive – no response

If experienced in its use, it may be appropriate to perform a more detailed assessment on the Glasgow Coma Scale (GCS).

You should then perform rapid neurological checks such as:

Pupils: PEARL – are the casualty’s pupils equal and reactive to light. Issues here might indicate a head injury, stroke, or hypoxia.

Limb Movement and Sensation: ask the casualty about any potential spinal injury, including asymmetry, weakness, or loss of feeling in any extremity. Consider the potential for a stroke and perform a “FAST” assessment.

Blood Glucose Level: sometimes abbreviated “BM” – ask if the casualty is diabetic, or has had any unconsciousness or confusion with no clear reason. If blood glucose is below 4mmol/L this can be managed with oral glucose.

Temperature: consider the potential for hypothermia and hyperthermia

Other causes: consider all other potential causes for a reduced consciousness level, such as sepsis, seizure, lightning strike, intoxication, and major bleeding.

If an injury or condition is encountered, treat appropriately and restart the primary survey.

Monitor Vital Signs

Record the casualty’s ACVPU and GCS score. This will act as a baseline and allow for improvement or deterioration to be determined later. Reassess these vital signs frequently.

When the disability assessment has been completed and any life-threatening conditions addressed, move on to exposure and environment.